Atopic Dermatitis

What is atopic dermatitis?

Atopic dermatitis is a long-term (chronic) skin disorder. It causes dry, itchy, scaly patches. These are often on the face and the head in babies. It’s most common in infants or very young children. Most will show signs of the condition in the first year of life. Symptoms may last until the teens or adulthood. It rarely starts in adulthood. It is not contagious.

Atopic dermatitis tends to run in families. This suggests a genetic link. It’s also linked to asthma and allergies. These are immune hypersensitivity disorders.

Treatment for this condition is aimed at calming the skin inflammation, decreasing the itching, and preventing infections. Good skin care and medicine to control itching and infection are used.

This condition is a type of eczema. Eczema is a general term that includes conditions that make the skin red, itchy, and inflamed. Atopic dermatitis is the most common type of eczema. So it is often called eczema.

What causes atopic dermatitis?

Experts don't know what causes this condition. It runs in families, which suggests a genetic link. It’s also linked to asthma and allergies. There is likely a change of the proteins in the skin that leads to atopic dermatitis. 

Certain triggers can make this condition worse. For example, stress, hot or cold temperature, dry conditions, certain fabrics, metals, or detergents can cause a flare-up.

What are the symptoms of atopic dermatitis?

The area of the body affected by atopic dermatitis may change with age. In babies and young children, it often affects the face, outside of the elbows, and the knees. In older children and adults, it tends to be on the hands and feet, the arms, the back of the knees, and the folds of the elbows.

Symptoms can be a bit different for each person. Common symptoms include:

• Dry, scaly skin patches

• Small bumps that open and ooze (weep) a clear fluid when scratched

• Skin redness and swelling

• Skin thickening (with chronic eczema)

• Scratch marks on the skin

Too much rubbing and scratching can tear the skin and lead to infection.

The symptoms of atopic dermatitis may seem like other skin conditions. Always talk with your healthcare provider for a diagnosis.

How is atopic dermatitis diagnosed?

Your healthcare provider will ask about your health history and if you have allergies or asthma. He or she will also ask about any family history of dermatitis, allergies, or asthma.  

A healthcare provider can often make a diagnosis by examining your skin. You may also have a patch test. This is a test to find allergies. Small amounts of allergens are placed on the skin. Then the skin is watched for a response. A skin biopsy may also be done to rule out other causes of the rash. 

How is atopic dermatitis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

There is no cure. The goals of treatment are to reduce itching and skin inflammation, to keep the skin moist, and to prevent infection.

Your healthcare provider may also prescribe medicines in severe cases. The following are often used to treat atopic dermatitis:

• Antihistamines. These medicines are taken by mouth (oral). They may help to ease itching. Some examples include diphenhydramine and hydroxyzine. They may cause drowsiness. Some newer antihistamines don’t cause drowsiness.

• Steroid creams. These are put on the skin to help ease inflammation, itching, and swelling. Many topical steroids are available in different strengths. If overused, they can cause skin thinning and discoloration.

• Systemic corticosteroids. These medicines ease inflammation, which can relieve itching. They are used for severe cases. They are available as a pill, liquid, or shot. These steroids have serious side effects from long-term use. So they are only used for a short time to stop a flare-up. 

• Oral antibiotics. These medicines kill bacteria that cause infections. Scratching the affected skin can bring bacteria to the area. This can lead to infection. Always take the antibiotic exactly as prescribed until it is all gone. 

• Oral cyclosporine. This medicine has been used for years to treat atopic dermatitis that doesn’t respond to other treatments. It was first developed to prevent rejection after organ transplantation. It suppresses the immune system. This stops it from overreacting. This helps prevent flare-ups. The medicine has many side effects. This should be considered carefully.

• Phototherapy. Two types are used to treat atopic dermatitis: ultraviolet (UV) light therapy and PUVA (chemophototherapy). Light therapy uses UV light of certain wavelengths to target the immune system. It stops the responses that lead to inflammation. PUVA therapy combines medicine and phototherapy. Phototherapy may be used along with other treatment. There are risks and benefits of light therapy. Weigh these risks with your healthcare provider. 

• Topical calcineurin inhibitors. These are nonsteroidal medicines that are put on the skin. They stop a part of the immune response that helps to reduce redness and itching.

• Methotrexate. An immunosuppressive medicine that can be used to manage atopic dermatitis long term. But it can possibly harm the liver.

• Barrier restoration creams. Similar to moisturizers, they help repair the skin and provide moisture. 

• Topical PDE4 inhibitor. This medicine blocks an enzyme that plays a role in causing inflammation. It is put on the skin, often twice a day.

• Biologic medicines. An injectable medicine called dupilumab is now available. This medicine blocks certain proteins from attaching to cells and causing inflammation. But this medicine is mostly used when other treatments haven't worked as well to control the condition.

What are possible complications of atopic dermatitis?

Complications of atopic dermatitis include:

• Dry skin that is easily irritated

• Skin infections

• Eye problems, such as eyelid dermatitis or cataracts

• Trouble in personal, family, or work relationships

Can atopic dermatitis be prevented?

Experts don't know what causes atopic dermatitis. So there is no known way to prevent it. But staying away from triggers may reduce flare-ups.

Living with atopic dermatitis

The following steps can help manage atopic dermatitis:

• Stay away from triggers

• Take short baths or showers using lukewarm water.

• Practice good skin care.

• Prevent infections.

• Don’t use harsh soaps. Ask your healthcare provider to recommend a brand.

• Dress in light clothes. Sweating can make atopic dermatitis worse.

• Wash new clothes before wearing them.

• Use a good moisturizer at least once a day. Ask your healthcare provider to recommend a brand.

• Don't scratch the affected area. Keep fingernails short and smooth.

• Reduce stress.

• Make lifestyle changes that prevent flare-ups.

• Don't use skin products that have fragrances and dyes.

When should I call my healthcare provider?

Tell your healthcare provider if:

• Your symptoms get worse

• You have new symptoms

Key points about atopic dermatitis

• Atopic dermatitis is a chronic skin disorder. It is often called eczema.

• It tends to run in families. It is most common in infants or very young children.

• It causes itching and dry, scaly, red skin. It has red bumps that open and ooze (weep) clear fluid when scratched.

• It’s important to find and stay away from the things that make it worse. Triggers include stress, high or low temperatures, bacterial infections, fabrics such as wool, metals, and detergents.

• There is no cure. The goals of treatment are to reduce itching and skin inflammation, keep the skin moisturized, and prevent infection.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.